'I suspect that the NHS IT programme will come good - after further tribulations'

Somewhere in the background Radio 4 is joining the newspapers ('Shame of the Filthy Wards') in trumpeting the Healthcare Commission's report that 99 out of 394 NHS trusts in England - one in four - are failing to meet at least one of the new compulsory hygiene standards, designed to beat MRSA and Clostridium difficile.

It's obviously not brilliant, but it does seem to constitute modest progress and the trusts' self-reporting seems more robust than during last year's row over candour. As with financial results, transparency feeds the 'NHS in crisis' agenda, as does the Commission's fondness for Monday morning embargoes: always a good day to promote bad news.

But the weekend news item which caught my eye was confirmation that Richard Granger, Connecting for Health chief executive and often described as 'Britain's highest-paid civil servant' -.a reported£292,000 -.is to leave his job.

A three-way commute between London, Leeds and young children in Cumbria is obviously a stretch even for a 42-year-old who eats software suppliers for breakfast. Ministers had been braced for him not to renew his five-year contract.

'There's no crisis, no bad feeling,' says one. The Sunday Times was set to run a 'Granger to quit' story, so he got his version out first in the Financial Times. He won't go until he's been replaced.

Where does it leave the programme? We have a clear idea of what MPs think. By near-coincidence the Tories staged a half-day debate in the Commons this month, in which Stephen O'Brien, shadow health secretary Andrew Lansley's deputy, set out an indictment - more in sorrow than anger.

Yes, they back the NHS's IT plans in principle, but deplore government failure to consult the professions earlier, its technical and management failures, its delays, its faltering suppliers, and parallel software problems with the medical training application service.

Ministers privately regard such talk as 'total crap' and point to the Granger record, so different from many in public sector procurement: tight specifications that require the supplier to take the risks and correct their own mistakes.

As Labour's Mark Todd and Tory Richard Bacon later pointed out, that is one reason why several suppliers/local service providers have bitten the dust - leading to what Mr O'Brien complained of as an over-concentration. 'A system which is both dysfunctional and late, with costs burgeoning against miniscule delivery,' as he put it.

Lib Dem spokesman Norman Lamb joined Tory calls for an independent review of technical issues; costs and delays; and the civil liberty fears lurking behind patient records the one part of the whole show which officials admit is still in difficulty. Folk still think dog-eared envelopes on trolleys are safer.

'My sister is a GP, and she said she would not, for one moment, agree to her personal medical information going on to the spine,' Mr Lamb confided.

Doctors have received no advice on storing PIN numbers; there are also concerns about relatives viewing sensitive online information, regardless of the penalties for abuse.

But two worthwhile backbench speeches caught my attention. Tory new boy Mr Bacon, a thoughtful member of the Commons public accounts committee, insisted Tony Blair had been misled into claiming the technical problems have all been solved; he also challenged software provider iSoft's claims and the propriety of it being taken over by CSC Alliance, the key provider across much of the country.

The other breath of common sense and expertise came from former IT director and leader of Cambridge City Council Mark Todd. He calmly warned of project creep and diversions, of the need for robust risk analysis, of changing ministerial teams and primary care trust reform, of the dangers that ambitious suppliers over-reach themselves.

Ministers are now eager to roll out the project as 'locally owned' at strategic health authority level. 'Clinical champions' are selling it to sceptical medics. I suspect it will come good - after further tribulations. Let's have 'continuous review' with external input, says Mark Todd - 'and keep our nerve'.